Provider Demographics
NPI:1558419176
Name:WELLS, DAVID E (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:WELLS
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5363 BALBOA BOULEVARD SUITE 234
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316
Mailing Address - Country:US
Mailing Address - Phone:818-788-4220
Mailing Address - Fax:
Practice Address - Street 1:5363 BALBOA BLVD STE 234
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2825
Practice Address - Country:US
Practice Address - Phone:818-788-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12853111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC12853AMedicare ID - Type Unspecified
CAT17457Medicare UPIN